foundations week 5 Los and grief focus on this

it is important to see patients for who they are since they can have a sense of loss of identity

true

scientific knowledge base of types on loss

developing a personal understanding of your own feelings about grief and death will help you better serve your patients

actual loss

necessary losses

maturational losses

situational losses

perceived loss

they are defined by the person perceiving the loss how they are taking the loss personally it is what the deem as loss

necessary losses

loss part of life

maturational losses-

occur across the lifespan so loss of grandfather

situational losses

sudden unpredicted so someone dies in an accident

Grief

an inidivdualized response to a loss that is perceived real or anticipated by the perosn expeirncing th eloss

uncomplicated normal grief

know cause and as they work through it they move past that loss

they are able to move past it

complicated grief

chronic-Complicated grief involves prolonged symptoms of painful emotions and sorrow for more than 1 year

exaggerated -self destructed, suicide, maladapted behaviors

delayed - not ready to dela with the loss until later

masked-absolutely not dealing with it at all but effect them

takes many years and they don’t move past that loss

Chronic grief

A person with chronic grief experiences a normal grief response, except that it extends for a longer period of time. This can include years to decades of intense grieving.

Exaggerated grief.

A person with an exaggerated grief response often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these individuals

Delayed grief

In delayed grief a person’s grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss. A delayed grief response is frequently triggered by a second loss, sometimes seemingly not as significant as the first loss—for example, a college student whose parent has died, but the full realization of the loss comes after the family pet dies or the student fails a course.

Masked grief

With masked grief, a survivor is not aware that their behaviors that interfere with normal functioning are a result of a loss. Physical symptoms exhibited by the masked grief could be headaches, heartburn, rashes, or tachycardia.

anticipatory grief

• can occur before the actual loss occurs

• grief can be seeing their loss of mobitly so that is anticpatory groef as they see loss of something or in the prcess of it

disenfranchised

• don’t have support to grief have no one to connect

• marginal unsupported

• example a partner who had a lover and the lover was unable to grieve and the wife does have support

• when their relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance. The person’s loss and grief do not meet the norms of grief acknowledged by the person’s culture, thereby cutting the grieving person off from social support and the sympathy given to people with more socially acceptable losses. Examples include the death of a former spouse, health care worker, or death from homicide, suicide, or terminated pregnancy

ambiguous loss a type fo disenfranchised loss

• no psychologically available

• a type of disenfranchised grief, can occur when the person who is lost is physically present but not psychologically available, as in cases of severe dementia or brain injury. Other times the person is gone (e.g., after a kidnapping, when someone is taken as a prisoner of war, when there is no body found after a disaster such as 9/11, or when someone “goes missing”), but the grieving person maintains an ongoing, intense psychological attachment, never sure of the reality of the situation.

factors influencing loss and grief

• human development

• personal relationships

• nature of the loss

• coping strategies

• socioeconomic loss

• culture

• spiritual and religious beleifs

how to help with grieving

• when caring who have experienced loss. facilitate the grief prvcess by helping survivors feel the loss express it and move through their grief

• loss comes in many forms based on the values and priorities learned within a person’s sphere of influence

• the type and perception of the loss influence how a person experiences grief

Kubler ros stages of grief/dying known as (DABDA)

• denial

• anger

• bargaining

• depression

• acceptance

DABDA is not an ordered process

true

bowl byes attachment theory

numbing-

yearning

seeking

disorganization

reorganization

DABDA D:

Denial

The person cannot accept the fact of the loss. It is a form of psychological protection from a loss that the person cannot yet bea

DABDA: A

Anger

The person expresses resistance or intense anger at God, other people, or the situation.

DABDA: B

Bargaining

The person cushions and postpones awareness of the loss by trying to prevent it from happening.

DABDA d 2nd:

Depression

The person realizes the full impact of the loss.

DABDA:A 2nd A

Acceptance

The person incorporates the loss into life.

numbing bowlby

Protects the person from the full impact of the loss

yearning and searching bowlby

Emotional outbursts of tearful sobbing and acute distress; common physical symptoms in this stage: tightness in chest and throat, shortness of breath, a feeling of lethargy, insomnia, and loss of appetite

disorganization and dispair bowlby

Endless examination of how and why the loss occurred or expressions of anger at anyone who seems responsible for the loss

Reorganization bowlbyes

Accepts the change, assumes unfamiliar roles, acquires new skills, builds new relationships, and begins to separate from the lost relationship without feeling that its importance is being lessened

bowlby’s theory is

attachment theory

can move in and out to the pahses

Rando’s R process model

Recognize the loss

React to the pain of separation

Recollect and reexperience the relationship with the deceased

Relinquish old attachments

Readjust to life after loss

Reinvest by putting emotional energy into new people

• depends on their personality coping styles cultural practices holistic

grief task model wordens

Accepts the reality of the loss

Experiences the pain of grief

Adjusts to a world in which the deceased is missing

Emotionally relocates the deceased and moves on with life

• they have to make the work and effor to reach out and suport cna be uselss withou eronal work

dual process model

• Loss-oriented activities: grief work, dwelling on the loss, breaking connections with the deceased person, and resisting activities to move past the grief

• Restoration-oriented activities: attending to life changes, finding new roles or relationships, coping with finances, and participating in distractions, which provide balance to the loss-oriented state

• Restoration dual

• -oriented activities: attending to life changes, finding new roles or relationships, coping with finances, and participating in distractions, which provide balance to the loss-oriented state

• Loss-oriented activities:

• grief work, dwelling on the loss, breaking connections with the deceased person, and resisting activities to move past the grief

rando

series of prcesses instead of satges or tasks

dual

accounts for gender and culture variations

warden

people should be actively involved in helping themselves

no one’s grief follows a pretdetermined path

true

Human development. factor on loss and grief

• Toddlers don’t understand death but react to separation with anxiety, changes in sleep/eating, fussiness, and bowel/bladder changes.

• School‑age children understand that death is permanent but may not grasp its causes. They show grief through strong emotions and changes in sleep, appetite, and social behavior.

• Young adults grieve losses related to disrupted future plans, identity formation, and independence.

• Middle‑aged adults face grief tied to major life transitions—caring for aging parents, marital changes, and shifting family roles.

• Older adults experience expected age‑related losses and may face ageism, but often show resilience due to life experience and established copin skills

personal relationships

• When loss involves another person, the quality and meaning of the lost relationship influence the grief response.

• When a relationship between two people was very rewarding and well connected, the survivor often finds it difficult to move forward after the death. Grief work is hampered by regret and a sense of unfinished business, especially when people are close but did not have a good relationship at the time of death.

• Social support and the ability to accept help from others are critical variables in recovery from loss and grief. Grievers experience less depression when they have highly satisfying personal relationships and friends to support them in their grief.

nature of the loss

• Understanding the type and nature of a loss (avoidable vs. unavoidable, permanent vs. temporary, actual vs. perceived) helps guide individualized nursing interventions.

• Encouraging patients to talk about their loss provides insight into how it affects their behavior, health, and overall well‑being.

• Visible, public losses (e.g., losing a home in a tornado) often bring strong community support.

• Private or less visible losses (e.g., miscarriage) tend to receive less social support.

• Sudden, unexpected deaths create unique challenges because survivors have no time to prepare or say goodbye.

• Chronic illness–related losses involve prolonged suffering and functional decline, shaping the grieving process differently.

• Violent deaths, suicide, or multiple losses complicate grief due to trauma, shock, or guilt—such as survivors wondering if they could have prevented a suicide.

coping strategies

• The losses that people face when they were children often influence the coping skills they will use when faced with larger and more painful losses in adulthood.

• These coping strategies such as talking, journaling, and sharing their emotions with others may be healthy and effective. Some strategies, such as using alcohol and drugs or acting out in violence, are unhealthy and ineffective. Nurses support patients by assessing their grief response and coping strategies, providing patient education, and encouraging the use of healthy coping strategies.

socioeconomic loss

• Socioeconomic status influences a person’s grief process in direct and indirect ways.

• For example, a newly widowed mother finds herself changing roles, needs to work several jobs to make ends meet, and does not find time to initiate self-care or grieve the loss of her spouse. With limited resources, activities that support healthy grief work such as buying a tree to plant in honor of the deceased or going to a support group may be unrealistic.

• Practical implications also exist when there are limited resources. An individual with limited finances may be unable to take time off work to attend a funeral or may be unable to travel to visit a dying family member.

culture

Patients and families rely on cultural and spiritual practices to find comfort, meaning, and ways to express grief.

• Grief expressions vary widely across cultures, and what feels normal in one culture may seem unfamiliar or confusing in another.

• Nurses should seek to understand each patient’s cultural values related to loss, death, and mourning.

• Some cultures value stoicism with minimal public emotion, while others show grief through public wailing, physical expressions, or even ritualized body practices.

• Culture is not limited to geography—it also includes sexual and gender identity, socioeconomic status, and family structure (e.g., blended vs. nuclear families).

• Considering these factors helps nurses provide respectful, individualized, culturally sensitive care during times of loss.

spiritual and religious beleifs

Spirituality and religion provide a framework for understanding, coping with, and healing from loss.

• A person’s faith shapes decisions and reactions related to illness, treatment choices, life‑support, autopsy, organ donation, and beliefs about the body and spirit after death.

• Patients often draw on spiritual beliefs for comfort, meaning, and hope during grief.

• Nurses must understand their own beliefs while staying open and respectful toward beliefs that differ from theirs.

• Assess each patient’s and family’s spiritual beliefs, practices, and sources of support (e.g., faith communities, prayer, meaning‑making, hope).

• Spirituality influences how well patients and families cope with loss, making it essential to use a holistic, individualized approach to care

hope

• a multidimensional concept considered to be a component of spirituality, energizes and provides comfort to individuals and families experiencing personal challenges. Hope gives a person the ability to see life as long-lasting or having meaning or purpose. With hope a patient moves from feelings of weakness and vulnerability to living as fully as possible. Maintaining a sense of hope depends in part on a person having strong relationships and emotional connectedness to others. On the other hand, spiritual distress often arises from a patient’s inability to feel hopeful or to foresee any favorable outcomes. Spirituality and hope play a vital role in a patient’s adjustment to loss and death

grief on older adults

• Age alone doesn’t determine grief responses—individual differences and the nature of the loss matter more.

• Older adults face more cumulative losses, especially in communal living where peers frequently pass away.

• Multiple losses increase the emotional burden, making grief more complex and harder to process.

• Complicated grief in older adults is linked to higher risks of mortality, heart disease, and cancer.

• Despite challenges, many older adults show strong resilience, offering examples of courage and adaptability.

• Older adults are at higher risk for complicated grief due to multiple losses, fewer resources, and reduced coping capacity.

• Chronic illness and physical decline can trigger grief over lost health, independence, and roles.

• Older adults benefit from the same therapeutic approaches as other age groups.

• Positive reappraisal (cognitive restructuring) helps them adapt—for example, reframing a cardiac diagnosis as motivation to adopt healthier habits.

• Key therapeutic goals include reducing depression and maintaining physical function during the grieving process.

when we asses

we look into coping style

nature of family relationships

social support systems

nature of the loss

cultural and spiritual beliefs

life goals

family grief patterns

self-care

sources of hope

• what do u understand about your diagnosis

• try to learn

-need to knw end of life wishes

5 wishes form

DNR

DNA

POLST

medical order

effective immediate

tells providers exactly what to do in an emergency

EMS must follow it

for serious and ill patients

DNR (Do Not Resuscitate)

A medical order stating the patient does not want CPR if their heart stops or they stop breathing.

• Must be signed by a health care provider.

• Used in hospitals, long‑term care, and sometimes at home depending on state laws.

• EMS and nurses must follow it.

Five Wishes Form

A legal advance directive that focuses on both medical and personal/emotional preferences. It is more holistic than a DNR/DNA.

The Five Wishes include:

1. Who you want to make decisions for you (health care proxy).

2. The kind of medical treatment you want or don’t want.

3. How comfortable you want to be (pain control, comfort measures).

4. How you want people to treat you (visitors, environment, emotional support).

5. What you want loved ones to know (messages, forgiveness, funeral wishes, personal values).

what are 5 things we should be asking terminally il pt.

We need to know

• What is your understanding of where you are and of your illness?

• Your fears/worries for the future

• Your goals/priorities

• What outcomes are unacceptable to you? What are you willing to sacrifice and not?

And later

What would a good day look like?

planning outcomes

• Care plans for the dying patient focus on

  • Comfort

  • Preserving dignity & quality of life

  • Providing family members with emotional, social, & spiritual support

• Give priority to a patient’s most urgent physical or psychological needs while also considering his or her expectations and priorities. 

palliative

prevention, relief, reduction, or soothing of symptoms 

throughout the entire course of an illness

• not just for dying!!!!!

HOSPICE CARE

• usually 12 months to live and not on aggressive medication such as chemo

• Care, comfort, & quality of life for a person with a serious illness who is approaching end of life

• give up aggressive treatment
  

NODA

No one Dies alone

implementation

• providing palliative or hospice care

• Using therapeutic communication

• Providing psychosocial care

• Managing symptoms

• Promoting dignity and self-esteem

• Ensuring a comfortable and peaceful environment

• Promoting spiritual comfort and hope

• Protecting against abandonment and isolation

• Supporting the grieving family

• Assisting with end-of-life decision making

• Facilitating mourning

Breath of Heaven connect non denomitional way

• Calming breath - Just breathe with me

• Breathe moderately, filling and emptying your lungs as evenly as possible

• Take in the air that nourishes you

• Let go of what is no longer useful 

• Take in nourishment

• Release what no longer nourishes you

Implementation: Care After Death

• Federal and state laws apply to certain events after death.

  • Documentation

  • Organ and tissue donation

  • Autopsy

  • Postmortem care

  • Maintain integrity of cultural & religious rituals

Organ Donation Fast Facts

can make a big impact

when they are a donor

the will be discharged, and family is not responsible of anything after that nor the recipient

Importance of Nurses’ Self-Care

• You cannot give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself. 

• Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. 

• Being a professional includes caring for yourself physically and emotionally. 

• To avoid the extremes of becoming overly involved in patients’ suffering or detaching from them, nurses develop self-care strategies to maintain balance. 

EAP:

Employee Assistance Program

see through the patients eyes

true